Histologic Categorization of Fibrotic Cancer Stroma in the Primary Tumor Is an Independent Prognostic Index in Resectable Colorectal Liver Metastasis
- 1 October 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The American Journal of Surgical Pathology
- Vol. 38 (10), 1380-1386
- https://doi.org/10.1097/pas.0000000000000232
Abstract
Although the molecular mechanism of desmoplastic reaction (DR) for providing aggressive tumor characteristics is increasingly recognized, the prognostic role of DR has not been investigated in colorectal liver metastasis (CRLM). A pathologic review of 412 patients who underwent hepatectomy for CRLM at 2 independent institutions was conducted. DR in primary tumors was classified as mature, intermediate, or immature on the basis of the existence of keloid-like collagen and myxoid stroma–distinctive histologic products of extracellular matrix remodeling. With respect to DR, 137, 122, and 153 patients were classified as mature, intermediate, and immature, respectively. Immature DRs were associated with higher T and N stages, higher primary tumor grade, synchronous and larger size of liver metastasis, and extrahepatic disease (P≤0.0001 to 0.002). DR significantly influenced the rate of recurrence in extrahepatic sites, including the lung, peritoneum, and local region in the primary tumor (P≤0.0001 to 0.03), rather than the remnant liver. Five-year overall survival rates after hepatectomy were the highest in the mature group (58.9%), followed by intermediate (42.1%) and immature (26.7%) groups. A significant prognostic impact of DR was observed in subset analyses for institutions, primary tumor location, and timing and number of liver metastases. Multivariate analysis revealed that DR was an independent prognostic factor along with T stage of the primary tumor, size of liver metastasis, and extrahepatic disease. Characterizing DR in the primary tumor on the basis of histologic products of cancer-associated fibroblasts is valuable in evaluating prognostic outcome after hepatectomy in CRLM patients.This publication has 27 references indexed in Scilit:
- The Pancreas Cancer MicroenvironmentClinical Cancer Research, 2012
- Hallmarks of Cancer: The Next GenerationCell, 2011
- Systematic Review of Randomized and Nonrandomized Trials of the Clinical Response and Outcomes of Neoadjuvant Systemic Chemotherapy for Resectable Colorectal Liver MetastasesAnnals of Surgical Oncology, 2009
- Comparison of clinical risk scores predicting prognosis after resection of colorectal liver metastasesJournal of Surgical Oncology, 2009
- A Prognostic System Applicable to Patients with Resectable Liver Metastasis from Colorectal Carcinoma Staged by Positron Emission Tomography with [18F]Fluoro-2-Deoxy-D-Glucose: Role of Primary Tumor VariablesJournal of the American College of Surgeons, 2008
- Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trialThe Lancet, 2008
- Microenvironmental regulation of metastasisNature Reviews Cancer, 2008
- The Extracellular Matrix Protein TGFBI Induces Microtubule Stabilization and Sensitizes Ovarian Cancers to PaclitaxelCancer Cell, 2007
- Direct Involvement of Breast Tumor Fibroblasts in the Modulation of Tamoxifen SensitivityThe American Journal of Pathology, 2007
- Histological categorisation of fibrotic cancer stroma in advanced rectal cancerGut, 2004